TPH and CAMH technical report: Written by TPH in collaboration with researchers at the Centre for Addiction and Mental Health's Problem Gambling Institute of Ontario Analyzes Canadian Community Health Survey data on gambling behaviour. Analyzes Ontario and GTA level data for 2007/08 cycle BOH report: Summarizes the issues and impacts on health related to problem gambling, as well as recommendations to mitigate the negative impacts. Was informed by the technical report and stakeholder interviews with other public health units, addiction research agencies and community service providers. Toronto Position Statement on Gambling and Health: Outlines TPH’s policy recommendations to address the negative health impacts of problem gambling.
Expansion of lottery sales: Multi lane retailers, supermarkets, big box stores (e.g. costco, walmart etc) Consolidation of gaming sites: Underperforming sites were closed- Windsor, Sarnia, Fort Erie (600 jobs lost) Improve Access to slots machines: Consider new markets for slots while removing them from underperforming locations e.g. racetracks. Huge impact on economic viability of racetracks 6. Shift to private sector: Policy control would remain with OLG, OLG is regulated by the Alcohol and Gaming Commission of Ontario. Plan to increase the number of private industry workers from 60% to almost 100% Stakeholder Consultations were conducted during the development of the business proposal. A complete listed is attached to the proposal. Here is a sample: - Many gaming industry stakeholders -Ontario Problem Gambling Research Centre (receives $4million/annually from MOHLTC) -CAMH -Ministry of Tourism
However there are many criticisms to the proposed benefits: Revenue Generation Money will come from other markets where ppl spend discretionary money (shows, theatre, restaurants, trips, clothing etc.), thus cannibalizing from other businesses Gambling revenue is highly inefficient vehicle for revenue generation- only 35% of Gambling Ontario revenue lands in the government purse (Robert Simpson, 2012) after overhead, beneficiaries, entitlements etc. are paid out) (vs ~70% in Alberta) Job creation (gambling sector, hospitality/service sectors) 2,300 new jobs created; 4,000 service and hospitality spinoffs (all permanent) Concerns that these jobs will be low paying jobs with poor benefits, if any. Catalyst for growth - concerns that many surrounding businesses will crumple and surrounding areas will lack or lose vitality (e.g Greenwood racetrack in the Beach - when race track closed, neighbourhood flourished residentially, although businesses have not performed as well as hoped)
Assessing a change in crime is complex, it depends on the nature of the crime under review. Some studies state small increases in crime, other state none. The kinds of crime that can be impacted include decreased illegal gambling, increased crime committed to support gambling, increased gambling related crimes such as loan sharking, money laundering etc. One has to be specific as to which crime rate is being assessed as overall crime rates may show little impact. (Williams et al, 2011). Crime - OLG cites 2 studies from U of Alberta that show no link between crime and gambling (I haven’t located the studies yet) Crime: Approximately 9% of total crime (FBI Index I) due to gambling in counties with Class III gambling. 8.6% of property crime; 12.6% of violent crime (American stats) Source: Earl L. Grinols and David B. Mustard, “Casinos, Crime, and Community Costs,” The Review of Economics and Statistics, 88, 1, February 2006, 28-45. Land use- casino areas become wastelands with no vitality around (Ken Greenberg)
Different researchers calculate and define problem gambling in different ways. Toronto Public Health defines problem gambling as behaviour that harms the gambler, their family and friends and community members. We focused on problem gamblers with the most severe form of gambling addiction. Problem gambling directly affects about 11,000 people aged 18+ (0.2% E ) in the GTA and 25,000 (0.3%) people in Ontario. Although this number seems small, it is similar to other health concerns such as: ten-year prev for certain cancers – lung (0.1%), colon and rectum (0.3%); inflammatory bowel disease (0.5%); HIV/AIDS (0.3%); past year’s use of ecstasy (0.5%) other illicit drugs (e.g. cocaine – 0.9%); anorexia and bulimia (0.3 – 1.0%); suicide attempts in 15+ yrs of age (0.3%) [See Qs and As, Q. 23 separate summary provided.] In addition, roughly 129,000 people aged 18+ (2.8%) in the GTA and 294,000 (3.0%) in Ontario are at-risk gamblers, based on their gambling patterns and likelihood of being harmed by their gambling. Note: “At-risk “ gamblers includes low-risk and moderate-risk gamblers.
There is no single way to calculate problem gambling prevalence. Researchers who define problem gambling as including those with moderate risk plus problem gambling estimate that the prevalence in Ontario is between 1.2% and 3.4%. TPH uses the term problem gambling to describe a continuum of gambling behaviour that creates negative consequences for the gambler, for others in his or her social network, or for the community However, in the analysis of Canadian Community Health Survey (CCHS) data we conducted at Toronto Public Health to determine prevalence, we focused on problem gamblers with the most severe form of gambling addiction, ( sometimes called “pathological gamblers ”), as a distinct subgroup, which is strongly associated with adverse health outcomes. According to CCHS data for adults 18+, problem gambling directly affects an estimated 11,000 people aged 18+ (0.2% E ) in the GTA and 25,000 (0.3%) in Ontario. Although a relatively small proportion of the population it is comparable (similar order of magnitude) to the prevalence for some other health concerns such as: ten-year prev for certain cancers – lung (0.1%), colon and rectum (0.3%); inflammatory bowel disease (0.5%); HIV/AIDS (0.3%); past year’s use of ecstasy (0.5%) other illicit drugs (e.g. cocaine – 0.9%); anorexia and bulimia (0.3 – 1.0%); suicide attempts in 15+ yrs of age (0.3%) [See Qs and As, Q. 23 separate summary provided.] In addition, approximately 129,000 people aged 18+ (2.8%) in the GTA and 294,000 (3.0%) in Ontario are at-risk gamblers, based on their gambling behaviour and likelihood of experiencing adverse consequences from gambling. Note: “At-risk “ gamblers includes low-risk and moderate-risk gamblers.
While the number of Toronto residents directly impacted by problem gambling is small, the health and social impacts extend beyond the gamblers themselves. Problem gambling has negative effects on the health and social well-being of family, friends, and communities Other aspects of gambling expansion may have positive or negative effects on health- such as employment, crime, traffic or economic development. These were not studied for this report, but the Board has asked TPH to report back in February 2013 on the community health impacts of a casino.
Self-reported general health is widely used as an indicator for overall health and well-being. TPH analysis indicates that as the risk for problem gambling increases, both self-reported health and mental health significantly decrease. In 2007/08, 61% of non-problem gamblers in Ontario rated their health as excellent or very good compared to 49% of low to moderate-risk gamblers and 33% E of problem gamblers. 76% of non-problem gamblers rated their mental health as excellent or very good compared to 69% of low to moderate-risk and 35% E of problem gamblers.
According to the TPH analysis of 2007/08 Canadian Community Health Survey (CCHS) data for Ontario, in the past 12 months, 77% of problem gamblers reported gambling as the cause of health problems compared to 11% of low to moderate-risk gamblers. 75% of problem gamblers reported gambling as the cause of financial problems for their families. 32% of problem gamblers reported having thoughts of committing suicide in their lifetime compared to 8% of non-problem gamblers. It is difficult to establish the actual number of suicides as a result of gambling, but research on gambling-related suicide in other jurisdictions suggests that this is an important public health concern linked to problem gambling.
Research has found that availability and accessibility of gambling opportunities has a strong association with problem gambling and that proximity to a gambling venue is a determinant of problem gambling. Toronto currently has a low baseline rate of gambling compared to Ontario as a whole and limited access to casinos. This suggests that the rate of problem gambling could increase. Adverse health impacts have been found for residents who live up to 80 kilometres away from a casino, although the effect tends to be greater for closer communities compared to those further away. (Currently the closest casino is ~ 80km away – Port Perry; although slots at Woodbine offer access to gambling opportunity within our City boundaries.) It is difficult to predict the effect that a new casino would have on the problem gambling rate in Toronto. Evidence from other jurisdictions suggests that the increase could vary from 0% to 100%. For example, a 1999 study examining the rates of pathological gambling (the most severe form of problem gambling) in Niagara Falls, Ontario reported an doubling from 2.2% prior to the casino opening to 4.4% one-year after the casino opening. On the other hand, in Windsor, Ontario gambling participation increased from 66% before the opening of the casino to 82% one year after the opening of the casino, while the rates of problem and pathological gambling remained stable. The main determinants of the magnitude of the increase in problem gambling rates usually include the local population’s prior exposure to casino gambling and the vulnerability of those populations. The fact that all potential sites being considered by OLG have vulnerable populations nearby could also result in an increase in problem gambling that is inequitable.
Gambling expansion has been identified as an issue by the public health community in Canada and internationally since the 1990s. Overall, our finding is that problem gambling, the main outcome consistently associated with access to casino gambling, is a serious public health concern because it is associated with a range of impacts on physical and mental health, Health impacts range from poor overall health, fatigue, to more serious conditions such as correlated substance use and addictions, depression and suicide. These health effects occur alongside other negative impacts such as financial difficulties, marital and family disruption and impaired child development. The impacts clearly extend beyond the individual For this reason I am strongly urging that decision-making by City Council be informed by full knowledge of the potential health impacts that may arise as a result.
Research shows that rather than treatment (which we know has very limited uptake among gamblers), more effective strategies focus on environmental parameters: restricting the general availability of gambling, restricting the number of gambling venues, restricting more harmful types of gambling and restricting the location of gambling venues among other options that have previously been identified by our colleagues such as CAMH’s PGIO. All of TPH’s recommendation s regarding gambling policy have been summarised in the Toronto Public Health Position Statement on Gambling and Health. Limiting gambling availability: Includes reducing or limiting the number of gambling venues Locating gambling venues away from vulnerable and dense communities Reducing hours of operation: Casino’s should be closed for at least 6 hours per day Restricting higher risk gambling modalities: e.g. electronic gaming machines (such as slot machines) which are most addictive, slowing down machine speed of play and restricting features that promote false beliefs about the odds of winning. Implementing harm reduction measures on site: These include prohibiting casino loyalty programs, eliminating access to credit and casino holding accounts, prohibiting ATM’s on the casino floor, restricting alcohol service, reducing the maximum bet size , imposing daily loss maximums, strengthening self-exclusion programs and issuing monthly individual patron statements.
Actual motion wording: Requested the City Manager: in conjunction with the Medical Officer of Health and the Centre for Addiction and Mental Health (CAMH), to consult with the Ontario Lottery and Gaming Corporation (OLG) to ensure that the economic benefits are weighed against potential social costs with a view to increasing the funding formula to enhance educational and addition support systems, to be incorporated into the requested report in February/March 2013
The Health Impacts of Gambling Expansion in Toronto
The Health Impacts of GamblingExpansion in TorontoDr. David McKeownMedical Officer of HealthJanuary 22, 2013
OLG Strategic Business Review“Modernizing Lottery and Gaming in Ontario”Highlights:1.Expansion of lottery sales2.Consolidation of gaming sites (closures)3.Improve access to slots machines4.2 new casinos in Ontario; 1 in GTA5.Consistent fee model for host municipalities6.Shift gaming operation to the private sector7.Build internet gaming site
A Casino in TorontoProcess for establishing a new casino:• OLG will review business cases• OLG will only proceed with municipal support• Municipalities must consult with their residentsPossible Toronto locations:• Exhibition Place• Metro Toronto Convention Centre• Portlands• Woodbine Racetrack (north-west)
Proposed Benefits of a Casino • Provincial + municipal revenue generation • Possible re-investment in health, education and community programs • Job creation/employment • Catalyst for economic growthOntario Lottery and Gaming Corporation (2011). Strategic business review: Modernizing lottery and gaming in Ontario. Available at:http://www.olg.ca/assets/documents/media/strategic_business_review2012.pdf
Possible Harms Associated with a Casino• The main indicator of the health and social impact of casinos is the association with problem gambling (Williams, Rehm & Stevens, 2011)Other Impacts:• Social service• Crime• Local businesses• Traffic 5
Problem Gambling• Problem gambling occurs when a person’s gambling harms themselves, their family or friends or others in the community• How measured?• CCHS module• PGSI
Prevalence of Problem Gambling• Some estimate that the Ontario prevalence of problem gambling (including both moderate risk and problem gamblers) is between 1.2% and 3.4%• Toronto Public Health focused on the most severe form of problem gambling - estimated 11,000 people aged 18+ (0.2%E) in the GTA and 25,000 (0.3%) in Ontario*• At-risk gamblers - approximately 129,000 people aged 18+ (2.8%) in the GTA and 294,000 (3.0%) in Ontario*E – Moderately high sampling variability; interpret with caution.* Data Source: Canadian Community Health Survey, 2007/08. Statistics Canada, Share File, Knowledge Management and ReportingBranch, Ontario Ministry of Health and Long-Term Care.
Effects of Problem GamblingPrepared by: Toronto Public Health. Adapted from Wyndham City. Responsible Gambling Strategy 2012-2014.
Effects of Problem Gambling For every problem gambler, about 3 to 4 other people are negatively impacted** Williams, R.J., Rehm, J. & Stevens, R.M.G. (2011). The social and economic impacts of gambling. Final report prepared for the Canadian Consortium for Gambling Research.March 11, 2011.Images from http://dapinographics.com/license-info
Health Impacts of Problem GamblingSelf-Reported Health and Mental Health by Type of Gambler, Aged 18+, Ontario, 2007/08Notes: (1) Gambling classifications are based on a modified version of the nine-item Problem Gambling Severity Index (PGSI), part of the Canadian ProblemGambling Index (CPGI). (2) Error bars (I) denote 95% confidence intervals. E – Moderately high sampling variability; interpret with caution. Low-risk andModerate-risk gamblers were combined due to small sample sizes. See Appendix for the full data table.Data Source: Canadian Community Health Survey, 2007/08. Statistics Canada, Share File, Knowledge Management and Reporting Branch, Ontario Ministryof Health and Long-Term Care.Prepared by: Toronto Public Health
Health Impacts of Problem GamblingHealth Impacts Reported "At least Sometimes" in Past 12 Months by Type of Gambler, Aged 18+, Ontario, 2007/08Notes: (1) Gambling classifications are based on a modified version of the nine-item Problem Gambling Severity Index (PGSI), part of the Canadian Problem Gambling Index(CPGI). (2) Error bars (I) denote 95% confidence intervals. (3) "At least sometimes" is an aggregate of almost always, most of the time and sometimes in the past 12 months. E –Moderately high sampling variability; interpret with caution. Low-risk and Moderate-risk gamblers were combined due to small sample sizes. Gambling caused health problems andfinancial problems are part of the PGSI and were used to classify type of gambler. Given this, we would anticipate significant differences between gambler types, These differencesare still meaningful and illustrate the differentiation in behaviour between problem gamblers and lower risk gamblers. Data Source: Canadian Community Health Survey, 2007/08.Statistics Canada, Share File, Knowledge Management and Reporting Branch, Ontario Ministry of Health and Long-Term Care. Prepared by: Toronto Public Health
Implications of a New Casino in Toronto• Overall evidence indicates that problem gambling tends to: – increase with availability – increase with proximity to a venue currently our closest casino is Port Perry – 80 km away – be unevenly distributed in the community males, youth, those with low-income, etc., are among the most vulnerable; all potential sites have vulnerable groups nearby• Size of impact is hard to predict• Toronto’s large size, diversity, low baseline access and prevalence of problem gambling could mean greater impacts
Conclusions• Problem gambling has negative health impacts on individuals, families and communities• Any expansion in gambling access in the GTA will likely increase health risks from problem gambling for Toronto and nearby communities, with a greater effect on closer communities compared to those further away• Board of Health – OLG should not be invited to establish a new casino in Toronto
Toronto Public Health Position Statement on Gambling and Health• Limit gambling availability• Mitigate impact on problem gambling by: – limiting hours of operation – restricting electronic gaming machine numbers, speed and operation – eliminating casino loyalty programs – prohibiting ATMs – prohibiting credit – reducing maximum bet size – mandating daily loss maximum – strengthening self-exclusion – issuing monthly statements – restricting alcohol purchase
Next Steps• February 11 report to Toronto’s Board of Health on Community Health Impacts• Public consultation ends January 25• www.toronto.ca/casinoconsultation• City Manager report to Executive Committee March 20• City Council decision (April 3, 4)
The Health Impacts of GamblingExpansion in TorontoDr. David McKeownMedical Officer of HealthJanuary 22, 2013